A case of interstitial pneumonia with autoimmune hemolytic anemia
Kenichiro Tamaki1) Daijiro Nabeya2) Taisuke Tsuji3) Mayumi Aoyama1) Yoshiro Kubo1)
1)Division of Respiratory Medicine, Kansai Electric Power Hospital 2)Division of Respiratory Medicine, Yodogawa Christian Hospital 3)Division of Respiratory Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center
A 71-year-old man noticed that he was producing brown urine in November 2007, and he also experienced dyspnea on exertion, a nonproductive cough and a pruritic eruption on his extremities and trunk in December 2007. He was admitted with suspected interstitial pneumonia (IP). IP was diagnosed based on the findings of blood tests, chest X-rays, computed tomography, bronchoalveolar lavage, and a transbronchial lung biopsy. His hemoglobin (Hb) level was low (6.4 g/dL), and autoimmune hemolytic anemia (AIHA) was diagnosed based on the presence of reticulocytosis (187%), a low level of haptoglobin (<10 mg/dL), and positive direct and indirect Coombs tests. His symptoms improved after receiving corticosteroid therapy. To the best of our knowledge there are only 15 reported cases of patients demonstrating the occurrence of these 2 diseases together. Most patients who develop AIHA first have a favorable prognosis, while those who develop IP first tend to have a poor prognosis. The current patient had increased levels of serum IgG, IgA and immunocomplexes. These findings suggest that IgG, IgA and immunocomplexes were associated with the comorbid IP and AIHA.
Interstitial pneumonia Autoimmune hemolytic anemia Lichenoid eruption Steroid Immunocomplex
Received 平成21年8月3日
JJRS, 48(6): 426-431, 2010